Obsessive–compulsive and related disorders are defined in DSM-5 and include obsessive–compulsive personality disorder 1 (OCPD) or anankastic personality disorder in ICD-10. 2 Its prevalence is believed to be 1–2% in the general population, but it occurs much more frequently in psychiatric populations Reference Fineberg, Reghunandanan, Kolli and Atmaca3 and is under-recognised and poorly researched, Reference Reddy, Vijay and Reddy4 although it is beginning to gather greater awareness. Reference Drummond5
In a clinical setting such patients can appear to function well and are often high achieving, so it can be difficult to ascertain what problems to target in treatment. However, family members and partners are often acutely aware of the difficulties of living with someone with OCPD and can provide valuable collateral information to mental health services.
OCPD is a personality type where the need for perfectionism in all aspects of life takes precedence. Individuals with OCPD hold high standards which originate from dysfunctional beliefs thought to be established in early adolescence. Reference Phillipson6 Straying away from these rigid beliefs can cause inner cognitive dissonance, leading them to push their beliefs onto others, creating difficulties in social interactions. Inflexible cognitions such as ‘my way is the correct way’, ‘I must own the truth’ and ‘all is not well unless it's done this way’ are deeply ingrained, so that they are resistant to acknowledging alternatives to their ways of thinking. Reference Phillipson7 In OCPD, inadequacies are only recognised in others and the external environment and patients do not harbour ego dystonia or question themselves.
On the surface, people with OCPD can appear confident, warm, organised and high-achieving; their meticulous standards can benefit them in certain professions. However, as with any personality disorder, overexpressed traits will cause dysfunction and OPCD frequently occurs with psychiatric comorbidities. Reference Reddy, Vijay and Reddy4 OCPD traits include preoccupation and insistence on details, rules, lists, order and organisation; perfectionism that interferes with completing tasks; excessive doubt and exercising caution; excessive conscientiousness, as well as rigidity and stubbornness. 1,2 Imagine this is a description for a potential partner. Undoubtedly, loved ones on the receiving end of the relationship will experience exhaustion, unhappiness and frustration. Living with people who have a fixed mindset and impose their opinions and outlook on life can lead to devastating effects.
Rigidity and inflexibility
People with an obsessional personality are often imprisoned in their own cage of fixation and therefore they cannot compromise. They are unable to change their views and may jeopardise relationships or their own personal or professional development as a result. They are willing to lose anything as they cannot break through the wall of obsessiveness.
Black or white, nothing in between
Dichotomous thinking features in obsessional personality – there is no acceptance of a grey area or anything left to chance. There is often tunnel vision, an inability to see beyond one's own standards and views. Anything that challenges this leads to resistance, frustration and anger. Perceiving everything in black or white gives an element of control. If something cannot be categorised as such, it causes inner turmoil, as it undermines a perfectionist's view of the world. Reference Phillipson7 An ‘all or nothing’ cognitive distortion maintains the high standards and if these are not met, it leads to dismissal of those who fall short of such standards.
Only their perception and method is correct
In OCPD there is a compelling need to do things in a particular way, which is perceived by the individual as the best, right and only way. Often it is based on little evidence or logic. Any objections lead to long arguments – such individuals, though unable to fully justify their position, vehemently maintain their beliefs. This can apply to any situation, from the banal to the most complex and significant.
This inability to shift in attitude can have detrimental consequences on relationships. It causes distress, oppression and exhaustion for the partners. The need of individuals with OCPD to remain firm in their perspective is more important than compromising in a situation. The cost of this may be losing a job or severely damaging relationships.
Low threshold for feeling hurt and humiliation
This is one of the major issues to work with when living with people with an obsessional personality. They have a very low threshold for feeling hurt and cannot cope with criticism. Any criticism is perceived as an attack on their already perfect standards and they are left feeling out of control. To avoid such criticism, they spend a long time making the ‘correct’ decision or remain indecisive and exercise extreme caution to avoid failure. Reference Phillipson7 This results in rumination and fixation and can cause deep hatred, anger and sadness.
Judging everyone with one's own standards
This is one of the major social deficits in people with OCPD and leads to a lack of emotional connection with others. There is immediate judgement of other people against their own gold standards, which are impossibly hard to achieve consistently. The individual with OCPD will quickly recognise the minutiae of flaws and expose them to the surface. Every aspect of the person's character is heavily scrutinised. Any ‘flaw’, however insignificant to others, will outweigh all other tremendously positive qualities of the other person and will result in disapproval. The patient with OCPD will be unable to focus on anything but the flaw and will see that as the main attribute of the person.
This very selective perception is entirely based on their own personality. In long-term relationships, this leads to incredible friction and will arouse negative emotions and grudges. There will be ongoing rumination against that person because of the perceived faulty behaviour or habit. This grudge will result in the individual with OCPD expending a great deal of effort to compel the other to change their behaviour. There may be a constant fixation on this, leading to the other person feeling oppressed. There may be constant pressure, nagging, criticising and altercations. There is no room for reasoning. This understandably leads to termination of relationships. This is frequently a repeating cycle of events but with a different person, situation or challenge to their standard. It is often found that people with OCPD fare well with those who are either very tolerant and patient, or have a passive, dependent personality (these people avoid conflict, rely on others to make decisions and will not challenge their partners' ways).
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